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Background@#Upadacitinib is an oral Janus kinase1 (JAK1)-selective inhibitor, which showed a quick and significant effect on patients with atopic dermatitis in several phase 3 clinical studies. Although, an increasing number of studies have reported data on the real-world efficacy and safety of upadacitinib for the treatment of atopic dermatitis, no studies have yet been published in Korea. @*Objective@#We assessed the real-world efficacy and safety of upadacitinib for the treatment of atopic dermatitis in Korean patients. @*Methods@#A total of 17 patients with atopic dermatitis who received 15 mg of oral upadacitinib everyday for 16 weeks, were included in this retrospective single-center study. Based on electronic medical records, the clinical characteristics, Eczema Area and Severity Index (EASI) score, and adverse events were investigated. @*Results@#The mean EASI score was significantly reduced at 4 weeks of upadacitinib treatment (8.81±9.00) and gradually reduced at week 8 (5.70±7.38), week 12 (4.55±6.23), and week 16 (4.58±6.74) (p＜0.001). At week 16, 61.54%, 30.77%, and 15.38% of patients achieved EASI 75, EASI 90, and EASI 100 responses, respectively. There was no statistically significant difference between EASI 75 and EASI 90 by age or gender at week 16 (p＞0.05). A total of 13 people (76.5%) had adverse events, of which acne was the most common. In all patients, the symptoms were mild and self-limited, and no patient discontinued treatment. @*Conclusion@#Upadacitinib was effective and safe for Korean patients with atopic dermatitis in real-world clinical practice.
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Background@#Adiponectin is an adipose-derived hormone that plays a role in various metabolic diseases. We previously demonstrated that adiponectin inhibits melanin synthesis through adenosine monophosphate-activated protein kinase (AMPK) activation in melanocytes. However, melanocytes can be affected by neighboring keratinocytes, and the effect of adiponectin on these functional units has not been investigated. @*Objective@#We investigated the effect of adiponectin on melanogenesis in co-cultured models of normal human melanocytes (NHMs), normal human keratinocytes (NHKs), and human dermal fibroblasts (HDFs), and the effect of adiponectin on melanin content in human skin tissues. @*Methods@#Quantitative real-time polymerase chain reaction (qPCR) was performed for tyrosinase and microphthalmia-associated transcription factor (MITF). The degree of phosphorylation of AMPK, cAMP response element binding protein (CREB), and AKT was evaluated by western blot assay, and Fontana-Masson staining was performed on cultured human skin tissues. @*Results@#Adiponectin decreased the melanin content in the co-culture models of NHMs with NHKs, NHMs with HDFs, and NHMs with both NHKs and HDFs. qPCR revealed that both tyrosinase and MITF were decreased after adiponectin treatment in the co-culture system. Following adiponectin treatment, AMPK was activated in all cell groups; however, the phosphorylation of CREB was decreased in HDFs and NHKs. The phosphorylation of AKT was decreased in only NHMs. In the experiment with human skin tissues cultured ex vivo, the densitometric analysis of Fontana-Masson staining revealed that adiponectin treatment reduced the melanin level of ultraviolet-irradiated human skin tissues. @*Conclusion@#Adiponectin inhibited melanogenesis in both co-culture models and human skin tissues ex vivo.
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Background@#Nipple adenoma (NA) is a rare benign tumor arising in the lactiferous ducts of the nipple. It typically presents as a palpable nodule, erosion, or discharge with erythema of the nipple. NA is different from other mammary proliferative diseases of the nipple; however, its clinicopathologic characteristics have been scarcely elucidated. @*Objective@#In this study, we aimed to assess the clinical and histopathological characteristics of NA and compare them with mammary Paget’s diseases and breast carcinomas of the nipple. @*Methods@#We retrospectively reviewed fifteen patients with NA. Furthermore, we reviewed fifteen patients with nipple Paget’s diseases and five patients with breast carcinomas (ductal carcinoma in situ and invasive ductal carcinoma). Skin lesions’ clinical characteristics and general histopathological findings were investigated. @*Results@#NA showed significantly early onset (p=0.014), delayed time for onset to diagnosis (p=0.026), and smaller lesion than other nipple malignant diseases (p＜0.001). NA was predominantly localized on the right side and exhibited as more palpable mass and less nipple discharge as initial symptoms. Estimated prevalence of Korean cases (0.026%) was twice higher than Western countries (0.012%). p16 immunostaining in NA and other malignant diseases did not differ. @*Conclusion@#NA is a benign neoplasm arising on the nipple. NA showed earlier onset with smaller size at initial presentation than other malignant diseases which presented more crusts. Unnecessary surgical procedures for NA should be avoided with preceding clinical differential diagnosis.
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Background@#Riehl’s melanosis of the face and neck has been reported in middle-aged women who have darker skin types. Recently, cases of Riehl’s melanosis have been on the rise in Korea, which might reflect the increased use of various cosmetic products and procedures. @*Objective@#This study was designed to analyze the clinicopathological characteristics and treatment outcomes of Riehl’s melanosis in Korean patients. @*Methods@#We closely observed 80 patients with Riehl’s melanosis diagnosed in Asan Medical Center and Hanyang University Medical Center between 2005 and 2015. A skin biopsy was analyzed in 51 patients, and a patch test was carried out in 16 patients. @*Results@#Patients with chronic Riehl’s melanosis (＞12 months) had an increased frequency of previous laser treatments. Patients with acute Riehl’s melanosis (＜3 months) reported a previous history of dry skin, itching, or irritation as a result of the use of hair dye. Patients older than 50 years, with darker skin type, and with a longer disease duration (＞12 months) had poor response rates. Chronic Riehl’s melanosis may be preceded by repeated irritation of barrier-compromised skin, and acute Riehl’s melanosis seems to be an allergic form of Riehl’s melanosis. @*Conclusion@#Riehl’s melanosis has different clinical manifestations according to disease duration and different treatment responses based on disease duration.
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Lymphomatoid contact dermatitis is a subset of cutaneous pseudolymphoma that clinically and histopathologically resembles both allergic contact dermatitis and cutaneous lymphoma. A variety of allergens have been reported since the first description of this entity in 1976. Lymphomatoid contact dermatitis is typically related to T cell hyperplasia. We herein describe a case of cutaneous B-cell lymphoid contact dermatitis caused by hair dye. This case demonstrates that lymphomatoid contact dermatitis can present with various clinical features and emphasizes the importance of thorough history-taking and examination for diagnosis.
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Background@#Madelung’s disease (MD) is characterized by multiple symmetric deposits of unencapsulated adipose tissue in the head, neck, and upper trunk. However, the etiology of lipoma tissue in MD remains controversial. @*Objective@#This study determined the clinicopathological and epidemiological features of Korean patients with MD and re-examined the hypothesis that lipomas of MD originate from brown fat. @*Methods@#We performed a single-institution, retrospective medical record review of 20 patients diagnosed with MD between January 1997 and August 2017. Biopsy slides were stained with nuclear factor IA (NFIA) and uncoupling protein 1 (UCP-1). @*Results@#The patients included were 2 women and 18 men with an average age of 64 (range, 27∼75) years. Ten patients reported heavy alcohol intake, and the remaining 10 reported some degree of alcohol intake. Hepatic disease was present in 47.7% of patients, only 16.7% had a body mass index ＞30 kg/m2, and 80% underwent surgical intervention. @*Conclusion@#MD affected mainly alcoholic men in the fourth decade. Alcoholism, hepatic disease, or severe obesity accounted for less than half of the Korean patients with MD. Immunohistochemical staining supported the hypothesis that MD lipomas originate from brown fat. Although the adipose tissue of all patients was stained with NFIA and UCP-1, the staining intensity varied. NFIA, which is a transcription factor required for the induction and maintenance of brown fat-specific gene expression, was more sensitive than UCP-1 for the detection of brown fat.
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Halo nevus clinically presents as a nevus with a surrounding ring of depigmentation that histopathologically demonstrates a dense lymphocytic reaction to the melanocytic component of the epidermis. While melanocytic nevi with halo phenomena are common, a halo reaction is uncommon in Spitz nevus. When a halo reaction develops around a Spitz nevus, differential diagnosis from melanoma arising from pre-existing nevus is difficult due to the presence of dense inflammatory components. A halo reaction itself can increase the cytologic atypia of melanocytes and can obscure nest maturation. Herein, we report rare cases of Spitz nevus combined with a halo reaction. It is important to note that the halo phenomenon can occur without a clinically evident white patch and that the architectural features of the nevus components can be used to distinguish Spitz nevus from malignant melanoma.
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Background@#Hyaluronic acid (HA) is the material used most often for soft tissue augmentation. Both agent factors, such as type of fillers and host factors, including technical manipulation, are known to affect the longevity of HA fillers. Although the relationship between longevity and filler composition has been widely studied, quantitative analysis to evaluate the difference in longevity of HA filler depending on injection depth has not yet been reported.Objective This study estimates injection depth-dependent degradation of HA filler in vivo using a rat model to evaluate its longevity. @*Methods@#Three Sprague–Dawley rats were assigned to each group based on sampling timepoints. Four injections were administered intradermally on one side of the back of rats and four more injections were administered subcutaneously on the other side. Histological specimens from the injected site were obtained at 2 (Group 1), 5 (Group 2), 9 (Group 3), 13 (Group 4), 20 (Group 5), and 33 (Group 6) weeks after initial implantation. External size of the implant site was calculated using caliper measurement at sampling timepoints. @*Results@#Although caliper-based analysis did not reveal a significant difference between intradermal and subdermal sites in all groups (p＞0.05), volumetric analysis of histological specimens demonstrated a difference in injection depth-dependent degradation rate. The volume ratio decreased over time in the subdermal injection sites, but it maintained a greater volume ratio than intradermal injection sites during the experiment (Groups 1∼6, p＜0.007).At 20 weeks after implantation, approximately half of the HA filler remained in the subdermal injection sites, whereas ＞80% of the filler was lost from intradermal injection sites. After the initial injection, time taken for the implant volume to reduce to half of its original value at intradermal and subdermal sites was 13 and 20 weeks, respectively. @*Conclusion@#This study demonstrates histological changes occurring in implanted HA filler materials over time and compares the injection depth-dependent longevity of materials. Caliper-based analysis did not show a significant difference between the intradermal and subdermal sites. However, quantitative analysis based on histological volumetric analysis revealed that subdermal injection lasts longer than intradermal injection.
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Pseudomyogenic hemangioendothelioma (PMH) is a rare vascular tumor and was recently recognized as a distinct entity. It has a predilection for young male adults and it frequently occurs in distal extremities. Although it is known to follow an indolent course, multi-focal presentation and local recurrence are common. PMH should be differentiated from epithelioid sarcoma, epithelioid hemangioendothelioma, dermatofibrosarcoma protuberans, and rhabdomyosarcoma. Its characteristic immunohistochemical staining pattern and recurrent translocation t(7:19)(q22:q13) are the basis for its diagnosis. Surgical excision is the mainstay treatment, although chemotherapy can be considered in non-operable patients. We present a rare case of a 40-year-old Korean male patient diagnosed with PMH through an excisional biopsy to facilitate the recognition PMH in the clinical practice.
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Dermal melanocytosis is characterized by an increased number of ovoid to elongated melanocytes situated between collagen fibers in the dermis, including blue nevus, Mongolian spots, nevus of Ota and Ito and dermal melanocyte hamartoma. Herein, we present a rare case of a 15-year-old boy presented with both dermal melanocyte hamartoma and Becker's nevus in conjunction with neurofibromatosis. A shared pathophysiologic mechanism between neurofibromatosis and other nevi in the context of organoid hamartoma has been reviewed.
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Cutaneous metastases of internal malignancies are relatively rare and originate most frequently from tumors of the breast and lung. Herein, we present an unusual clinical presentation of a skin metastasis from a gastric signet-ring cell carcinoma in an adolescent. A 19-year-old boy presented with asymptomatic subcutaneous nodules on his abdomen and back. Histopathological examination revealed signet-ring cells with cytoplasmic mucin in the dermis. A diagnosis of cutaneous metastasis of a signet-ring cell carcinoma was made and the patient died 12 days after his initial visit to our dermatology clinic. Gastric carcinomas have infrequently been reported in adolescents, and cutaneous metastases from carcinomas in this group are extremely rare. Clinicians should be aware that skin metastases of adolescent gastric carcinoma can be similar in presentation to steatocystoma multiplex and that a skin biopsy is necessary for suspicious skin lesions.
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No abstract available.
Subject(s)
Humans , Churg-Strauss Syndrome , Eosinophils , Erythema , Granulomatosis with Polyangiitis , Hypereosinophilic SyndromeABSTRACT
Leiomyosarcoma is a rare and aggressive soft tissue sarcoma originating in smooth muscle cells. There are two forms of primary superficial leiomyosarcomas depending on the origin and prognosis, one derived from the dermis and the other from the subcutaneous tissue of the skin. Middle-aged to elderly men are particularly affected by this type of cancer. Leiomyosarcomas of the head and neck are quite rare, accounting for approximately 3%~10% of all cases. We report herein a case of subcutaneous leiomyosarcoma of the scalp in a 47-year-old female patient.